, TESTBANK FOR Spinal Cord Injury Functional Rehabilitation 4th Edition
Somers
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,Chapter 2 Spinal Cord Injuries
Multiple Choice
1. A patient has a spinal cord injury. The motor levels are right C5 and left C6. The sensory
levels are right C7 and left C8. What is the single neurological level of injury?
a. C5
b. C6
c. C7
d. C8
Answer: a
Rationale
a If a lesion is asymmetrical, a person may have as many as four sensory and motor levels:
right sensory, left sensory, right motor, and left motor. The single neurological level of
injury (NLI) is the most rostral (highest) of these four levels. In this case, C5 is the most
rostral of the patient’s motor and sensory levels.
b C6 is not the most rostral of the patient’s motor and sensory levels.
c C7 is not the most rostral of the patient’s motor and sensory levels.
d C8 is not the most rostral of the patient’s motor and sensory levels.
2. A patient who has a spinal cord injury tests 0 in all key muscles, as well as all key sensory
points, on both sides of the body. They are able to contract the anus voluntarily and can sense
deep anal pressure. What is the correct American Spinal Injury Association (ASIA) Impairment
Scale (AIS) classification for this patient’s lesion?
a. A
b. B
c. C
d. D
Answer: c
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, Rationale
c Because the patient exhibits motor sparing in the lowest sacral segment (voluntary anal
contraction), the AIS classification is C.
a The AIS A classification requires absent motor and sensory sparing in the lowest sacral
segment. This patient has both motor (voluntary anal contraction) and sensory (deep anal
pressure) sparing.
b The AIS B classification requires that no motor function is preserved more than three
levels below the motor level on either side of the body. The voluntary motor function
shown with voluntary anal contraction indicates that the AIS classification is C, not B.
d The AIS D classification requires at least half of key muscle functions below the NLI to
have a muscle grade of 3 or greater. This patient exhibits 0 strength in all key muscles.
3. Of the following options, which is MOST likely to trigger an episode of autonomic
dysreflexia?
a. Moving from supine to sitting
b. Moving from sitting to supine
c. Fatigue
d. Full bladder
Answer: d
Rationale
d Any noxious stimulus below the lesion can cause autonomic dysreflexia (AD). Common
origins of this noxious stimulus include bladder or rectal distention, urinary tract
infection, and bowel impaction.
a Change in position is not a noxious stimulus below the lesion. Moving from supine to
sitting can cause orthostatic hypotension (OH), not AD.
b Change in position is not a noxious stimulus below the lesion.
c Fatigue is not a noxious stimulus below the lesion.
4. A patient has more severe weakness in the upper extremities than in the lower extremities.
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,These findings are MOST consistent with
a. Brown-Séquard syndrome
b. Anterior cord syndrome
c. Central cord syndrome
d. Posterior cord syndrome
Answer: c
Rationale
c People with central cord syndrome exhibit more pronounced weakness in their upper
extremities than in their lower extremities.
a People with Brown-Séquard syndrome exhibit more severe motor and proprioceptive
deficits on the side of the lesion and more severe loss of sensitivity to pin prick and
temperature on the contralateral side.
b Anterior cord syndrome is associated with preserved proprioception and light touch
combined with variable loss of motor function and pain and temperature sensation.
d Posterior cord syndrome is associated with loss of proprioception, vibratory sensation,
and two-point discrimination. Deep pressure may also be impaired.
5. Which of the following muscles or muscle groups is the C6 key muscle for International
Standards for Neurological Classification of Spinal Cord Injuries (ISNCSCI) classification?
a. Elbow extensors
b. Wrist extensors
c. Finger flexors
d. Elbow flexors
Answer: b
Rationale
b Wrist extensors are the C6 key muscles.
a Elbow extensors are the C7 key muscles.
c Finger flexors are the C8 key muscles.
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, d Elbow flexors are the C5 key muscles.
6. A patient has T3 paraplegia resulting from an injury 1 week ago. After the therapist assists
them into a short-sitting position at the edge of the bed, the patient reports feeling as if they are
about to pass out. Which of the following conditions should the therapist suspect based on the
patient’s report?
a. Autonomic dysreflexia
b. Reduced exercise tolerance
c. Myocardial infarction
d. Orthostatic hypotension
Answer: d
Rationale
d Orthostatic hypotension (OH) is characterized by a drop in blood pressure that occurs
when the individual moves from a horizontal to an upright position. A person with OH
may experience, among other things, dizziness, lightheadedness, ringing in the ears, and
loss of consciousness. OH typically is transient and resolves within a few weeks of
injury. The patient’s reported symptoms, time since injury, and apparent triggering by a
change of position are all consistent with OH.
a Autonomic dysreflexia (AD) is triggered by a noxious stimulus below the lesion, not a
change in position as described in this question. Symptoms of AD include a pounding
headache, blurred vision, spots in the visual fields, nasal congestion, paresthesias in the
neck and shoulders, and anxiety. Typically, AD first appears 6 or more months after the
injury. The patient’s reported symptoms, time since injury, and apparent triggering by a
change of position are all consistent with OH, not AD.
b This patient’s symptoms are brought on by a change in position, not exercise.
c The patient’s reported symptoms, time since injury, and apparent triggering by a change
of position are all consistent with OH. Although lightheadedness and sudden dizziness
can be associated with myocardial infarction (MI), this question does not describe any
other signs or symptoms that could indicate an MI.
7. Which of the following options BEST describes spinal shock?
a. Demyelination of axons in the peripheral portion of the spinal cord
b. Destruction of cell bodies in the central portion of the spinal cord
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,c. Permanent cessation of spinal cord function below the lesion
d. Temporary cessation of spinal cord function below the lesion
Answer: d
Rationale
d Spinal shock is a transient phenomenon that occurs after trauma to the spinal cord.
Spinal reflexes, voluntary motor and sensory function, and autonomic control are absent
or depressed caudal to the lesion during spinal shock.
a Demyelination of axons is one of the mechanisms of secondary tissue destruction that
follows spinal cord injury, but it is not an accurate description of spinal shock.
b Destruction of cell bodies within the spinal cord is a mechanism of the primary injury to
the cord caused by blunt trauma, but it is not an accurate description of spinal shock.
c Spinal shock involves temporary, not permanent, cessation of spinal cord function below
the lesion.
8. Case-Based Scenario: A patient who has sustained a traumatic spinal cord injury presents
with the following motor and sensory examination results.
Voluntary Motor Function:
R L R L
Quadriceps 3/5 4/5 Gluteus maximus 0/5 0/5
5/5 5/5 Anterior tibialis 2/5 3/5
Plantar flexors 0/5 0/5 Hamstrings 0/5 0/5
Long toe extensors 0/5 0/5 Gluteus medius 0/5 0/5
All upper extremity muscle strength is 5/5.
Rectus abdominis contraction is palpable from the ribs to the pubis.
Voluntary anal contraction is absent.
Sensation:
In key sensory points bilaterally, light touch and pin prick are intact in C1 to L4,
diminished in L5, and absent below L5. Deep anal pressure sensation is absent.
What are the patient’s motor levels using ISNCSCI classification?
a. Right L2, left L2
b. Right L3, left L3
c. Right L2, left L3
d. Right L3, left L4
Answer: b
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, Rationale
b On both the right and left, the L3 key muscles (knee extensors) are the most caudally
innervated muscles that exhibit grade 3 or higher muscle strength with all key muscles
rostral to that level (hip flexors, upper extremity muscles) exhibiting grade 5 strength.
a On both the right and left, the L3 key muscles (knee extensors), not the L2 key muscles
(hip flexors), are the most caudally innervated muscles that exhibit grade 3 or higher
muscle strength with all key muscles rostral to that level exhibiting grade 5 strength.
c L2 on the right is incorrect because the L3 key muscle on that side has grade 3 strength
and all key muscles rostral to L3 have grade 5 strength.
d L4 on the left is incorrect because, although the L4 key muscle (dorsiflexors) test grade
3, the next more rostral muscle (quadriceps, L3) exhibits only grade 4 strength.
9. Case-Based Scenario: A patient who has sustained a traumatic spinal cord injury presents
with the following motor and sensory examination results.
Voluntary Motor Function:
R L R L
Quadriceps 3/5 4/5 Gluteus maximus 0/5 0/5
Hip flexors 5/5 5/5 Anterior tibialis 2/5 3/5
Plantar flexors 0/5 0/5 Hamstrings 0/5 0/5
Long toe extensors 0/5 0/5 Gluteus medius 0/5 0/5
All upper extremity muscle strength is 5/5.
Rectus abdominis contraction is palpable from the ribs to the pubis.
Voluntary anal contraction is absent.
Sensation:
In key sensory points bilaterally, light touch and pin prick are intact in C1 to L4,
diminished in L5, and absent below L5. Deep anal pressure sensation is absent.
What is the single neurological level of injury using ISNCSCI classification?
a. L2
b. L3
c. L4
d. L5
Answer: b
Rationale
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, b A person may have as many as four sensory and motor levels: right sensory, left sensory,
right motor, and left motor. The single NLI is the most rostral (highest) of these four
levels. The motor level is L3 on both sides. Sensory level is L4 bilaterally. Thus, L3, the
most rostral of these two levels, is the single NLI.
a The NLI is L3, not L2, because the highest motor or sensory level for this patient is L3.
c The NLI is L3, not L4, because the highest motor or sensory level for this patient is L3.
d The NLI is L3, not L5, because the highest motor or sensory level for this patient is L3.
10. Case-Based Scenario: A patient who has sustained a traumatic spinal cord injury presents
with the following motor and sensory examination results.
Voluntary Motor Function:
R L R L
Quadriceps 3/5 4/5 Gluteus maximus 0/5 0/5
Hip flexors 5/5 5/5 Anterior tibialis 2/5 3/5
Plantar flexors 0/5 0/5 Hamstrings 0/5 0/5
Long toe extensors 0/5 0/5 Gluteus medius 0/5 0/5
All upper extremity muscle strength is 5/5.
Rectus abdominis contraction is palpable from the ribs to the pubis.
Voluntary anal contraction is absent.
Sensation:
In key sensory points bilaterally, light touch and pin prick are intact in C1 to L4,
diminished in L5, and absent below L5. Deep anal pressure sensation is absent.
What is the AIS (ASIA Impairment Scale) classification of this spinal cord injury?
a. A
b. B
c. C
d. D
Answer: a
Rationale
a Because there is no sensory or motor sparing in the lowest sacral segment, including no
deep anal pressure sensation or voluntary anal contraction, this patient’s lesion is
complete (AIS A).
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, b The AIS B classification requires sparing of light touch and/or pin prick sensation in the
S4 to S5 key sensory point, sparing of deep anal pressure, or both.
c This patient’s lesion is complete (AIS A) because there is no sensory or motor sparing in
the lowest sacral segment.
d This patient’s lesion is complete (AIS A) because there is no sensory or motor sparing in
the lowest sacral segment.
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in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.
Use of this content outside your academic institution is expressly prohibited and enforceable by law.
Somers
Important Notes
The file includes the complete test bank, organized chapter by chapter.
A sample of selected pages has been provided for preview.
All available appendices and Excel files (if included in the original resources) are
provided.
We continuously update our files to ensure you receive the latest and most accurate
editions.
New editions are added regularly – stay connected for updates!
⚠️Note on Answer Keys: If the answer key is not included within the chapter
questions, you will find the complete answers and solutions at the end of each
chapter.
✅ Why Buy From Us?
📚 Complete & organized chapter-by-chapter – no missing content, no guessing.
⚡ Instant digital delivery – get your file the moment you pay, no waiting.
📅 Always up to date – we track new editions so you always get the latest version.
💬 Friendly support – real humans ready to help, anytime you need us.
🔒 Safe & secure – thousands of satisfied students trust us every semester.
🛡️Our Guarantees
💰 Money-Back Guarantee: Not satisfied? We offer a full refund – no questions asked.
🔄 Wrong File? No Problem: Contact us and we will replace it immediately with the
correct version, free of charge.
⏰ 24/7 Support: We are always here – reach out anytime and expect a fast response.
Contact Email:
,Chapter 2 Spinal Cord Injuries
Multiple Choice
1. A patient has a spinal cord injury. The motor levels are right C5 and left C6. The sensory
levels are right C7 and left C8. What is the single neurological level of injury?
a. C5
b. C6
c. C7
d. C8
Answer: a
Rationale
a If a lesion is asymmetrical, a person may have as many as four sensory and motor levels:
right sensory, left sensory, right motor, and left motor. The single neurological level of
injury (NLI) is the most rostral (highest) of these four levels. In this case, C5 is the most
rostral of the patient’s motor and sensory levels.
b C6 is not the most rostral of the patient’s motor and sensory levels.
c C7 is not the most rostral of the patient’s motor and sensory levels.
d C8 is not the most rostral of the patient’s motor and sensory levels.
2. A patient who has a spinal cord injury tests 0 in all key muscles, as well as all key sensory
points, on both sides of the body. They are able to contract the anus voluntarily and can sense
deep anal pressure. What is the correct American Spinal Injury Association (ASIA) Impairment
Scale (AIS) classification for this patient’s lesion?
a. A
b. B
c. C
d. D
Answer: c
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in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.
Use of this content outside your academic institution is expressly prohibited and enforceable by law.
, Rationale
c Because the patient exhibits motor sparing in the lowest sacral segment (voluntary anal
contraction), the AIS classification is C.
a The AIS A classification requires absent motor and sensory sparing in the lowest sacral
segment. This patient has both motor (voluntary anal contraction) and sensory (deep anal
pressure) sparing.
b The AIS B classification requires that no motor function is preserved more than three
levels below the motor level on either side of the body. The voluntary motor function
shown with voluntary anal contraction indicates that the AIS classification is C, not B.
d The AIS D classification requires at least half of key muscle functions below the NLI to
have a muscle grade of 3 or greater. This patient exhibits 0 strength in all key muscles.
3. Of the following options, which is MOST likely to trigger an episode of autonomic
dysreflexia?
a. Moving from supine to sitting
b. Moving from sitting to supine
c. Fatigue
d. Full bladder
Answer: d
Rationale
d Any noxious stimulus below the lesion can cause autonomic dysreflexia (AD). Common
origins of this noxious stimulus include bladder or rectal distention, urinary tract
infection, and bowel impaction.
a Change in position is not a noxious stimulus below the lesion. Moving from supine to
sitting can cause orthostatic hypotension (OH), not AD.
b Change in position is not a noxious stimulus below the lesion.
c Fatigue is not a noxious stimulus below the lesion.
4. A patient has more severe weakness in the upper extremities than in the lower extremities.
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in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.
Use of this content outside your academic institution is expressly prohibited and enforceable by law.
,These findings are MOST consistent with
a. Brown-Séquard syndrome
b. Anterior cord syndrome
c. Central cord syndrome
d. Posterior cord syndrome
Answer: c
Rationale
c People with central cord syndrome exhibit more pronounced weakness in their upper
extremities than in their lower extremities.
a People with Brown-Séquard syndrome exhibit more severe motor and proprioceptive
deficits on the side of the lesion and more severe loss of sensitivity to pin prick and
temperature on the contralateral side.
b Anterior cord syndrome is associated with preserved proprioception and light touch
combined with variable loss of motor function and pain and temperature sensation.
d Posterior cord syndrome is associated with loss of proprioception, vibratory sensation,
and two-point discrimination. Deep pressure may also be impaired.
5. Which of the following muscles or muscle groups is the C6 key muscle for International
Standards for Neurological Classification of Spinal Cord Injuries (ISNCSCI) classification?
a. Elbow extensors
b. Wrist extensors
c. Finger flexors
d. Elbow flexors
Answer: b
Rationale
b Wrist extensors are the C6 key muscles.
a Elbow extensors are the C7 key muscles.
c Finger flexors are the C8 key muscles.
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in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.
Use of this content outside your academic institution is expressly prohibited and enforceable by law.
, d Elbow flexors are the C5 key muscles.
6. A patient has T3 paraplegia resulting from an injury 1 week ago. After the therapist assists
them into a short-sitting position at the edge of the bed, the patient reports feeling as if they are
about to pass out. Which of the following conditions should the therapist suspect based on the
patient’s report?
a. Autonomic dysreflexia
b. Reduced exercise tolerance
c. Myocardial infarction
d. Orthostatic hypotension
Answer: d
Rationale
d Orthostatic hypotension (OH) is characterized by a drop in blood pressure that occurs
when the individual moves from a horizontal to an upright position. A person with OH
may experience, among other things, dizziness, lightheadedness, ringing in the ears, and
loss of consciousness. OH typically is transient and resolves within a few weeks of
injury. The patient’s reported symptoms, time since injury, and apparent triggering by a
change of position are all consistent with OH.
a Autonomic dysreflexia (AD) is triggered by a noxious stimulus below the lesion, not a
change in position as described in this question. Symptoms of AD include a pounding
headache, blurred vision, spots in the visual fields, nasal congestion, paresthesias in the
neck and shoulders, and anxiety. Typically, AD first appears 6 or more months after the
injury. The patient’s reported symptoms, time since injury, and apparent triggering by a
change of position are all consistent with OH, not AD.
b This patient’s symptoms are brought on by a change in position, not exercise.
c The patient’s reported symptoms, time since injury, and apparent triggering by a change
of position are all consistent with OH. Although lightheadedness and sudden dizziness
can be associated with myocardial infarction (MI), this question does not describe any
other signs or symptoms that could indicate an MI.
7. Which of the following options BEST describes spinal shock?
a. Demyelination of axons in the peripheral portion of the spinal cord
b. Destruction of cell bodies in the central portion of the spinal cord
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,c. Permanent cessation of spinal cord function below the lesion
d. Temporary cessation of spinal cord function below the lesion
Answer: d
Rationale
d Spinal shock is a transient phenomenon that occurs after trauma to the spinal cord.
Spinal reflexes, voluntary motor and sensory function, and autonomic control are absent
or depressed caudal to the lesion during spinal shock.
a Demyelination of axons is one of the mechanisms of secondary tissue destruction that
follows spinal cord injury, but it is not an accurate description of spinal shock.
b Destruction of cell bodies within the spinal cord is a mechanism of the primary injury to
the cord caused by blunt trauma, but it is not an accurate description of spinal shock.
c Spinal shock involves temporary, not permanent, cessation of spinal cord function below
the lesion.
8. Case-Based Scenario: A patient who has sustained a traumatic spinal cord injury presents
with the following motor and sensory examination results.
Voluntary Motor Function:
R L R L
Quadriceps 3/5 4/5 Gluteus maximus 0/5 0/5
5/5 5/5 Anterior tibialis 2/5 3/5
Plantar flexors 0/5 0/5 Hamstrings 0/5 0/5
Long toe extensors 0/5 0/5 Gluteus medius 0/5 0/5
All upper extremity muscle strength is 5/5.
Rectus abdominis contraction is palpable from the ribs to the pubis.
Voluntary anal contraction is absent.
Sensation:
In key sensory points bilaterally, light touch and pin prick are intact in C1 to L4,
diminished in L5, and absent below L5. Deep anal pressure sensation is absent.
What are the patient’s motor levels using ISNCSCI classification?
a. Right L2, left L2
b. Right L3, left L3
c. Right L2, left L3
d. Right L3, left L4
Answer: b
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in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.
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, Rationale
b On both the right and left, the L3 key muscles (knee extensors) are the most caudally
innervated muscles that exhibit grade 3 or higher muscle strength with all key muscles
rostral to that level (hip flexors, upper extremity muscles) exhibiting grade 5 strength.
a On both the right and left, the L3 key muscles (knee extensors), not the L2 key muscles
(hip flexors), are the most caudally innervated muscles that exhibit grade 3 or higher
muscle strength with all key muscles rostral to that level exhibiting grade 5 strength.
c L2 on the right is incorrect because the L3 key muscle on that side has grade 3 strength
and all key muscles rostral to L3 have grade 5 strength.
d L4 on the left is incorrect because, although the L4 key muscle (dorsiflexors) test grade
3, the next more rostral muscle (quadriceps, L3) exhibits only grade 4 strength.
9. Case-Based Scenario: A patient who has sustained a traumatic spinal cord injury presents
with the following motor and sensory examination results.
Voluntary Motor Function:
R L R L
Quadriceps 3/5 4/5 Gluteus maximus 0/5 0/5
Hip flexors 5/5 5/5 Anterior tibialis 2/5 3/5
Plantar flexors 0/5 0/5 Hamstrings 0/5 0/5
Long toe extensors 0/5 0/5 Gluteus medius 0/5 0/5
All upper extremity muscle strength is 5/5.
Rectus abdominis contraction is palpable from the ribs to the pubis.
Voluntary anal contraction is absent.
Sensation:
In key sensory points bilaterally, light touch and pin prick are intact in C1 to L4,
diminished in L5, and absent below L5. Deep anal pressure sensation is absent.
What is the single neurological level of injury using ISNCSCI classification?
a. L2
b. L3
c. L4
d. L5
Answer: b
Rationale
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, b A person may have as many as four sensory and motor levels: right sensory, left sensory,
right motor, and left motor. The single NLI is the most rostral (highest) of these four
levels. The motor level is L3 on both sides. Sensory level is L4 bilaterally. Thus, L3, the
most rostral of these two levels, is the single NLI.
a The NLI is L3, not L2, because the highest motor or sensory level for this patient is L3.
c The NLI is L3, not L4, because the highest motor or sensory level for this patient is L3.
d The NLI is L3, not L5, because the highest motor or sensory level for this patient is L3.
10. Case-Based Scenario: A patient who has sustained a traumatic spinal cord injury presents
with the following motor and sensory examination results.
Voluntary Motor Function:
R L R L
Quadriceps 3/5 4/5 Gluteus maximus 0/5 0/5
Hip flexors 5/5 5/5 Anterior tibialis 2/5 3/5
Plantar flexors 0/5 0/5 Hamstrings 0/5 0/5
Long toe extensors 0/5 0/5 Gluteus medius 0/5 0/5
All upper extremity muscle strength is 5/5.
Rectus abdominis contraction is palpable from the ribs to the pubis.
Voluntary anal contraction is absent.
Sensation:
In key sensory points bilaterally, light touch and pin prick are intact in C1 to L4,
diminished in L5, and absent below L5. Deep anal pressure sensation is absent.
What is the AIS (ASIA Impairment Scale) classification of this spinal cord injury?
a. A
b. B
c. C
d. D
Answer: a
Rationale
a Because there is no sensory or motor sparing in the lowest sacral segment, including no
deep anal pressure sensation or voluntary anal contraction, this patient’s lesion is
complete (AIS A).
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, b The AIS B classification requires sparing of light touch and/or pin prick sensation in the
S4 to S5 key sensory point, sparing of deep anal pressure, or both.
c This patient’s lesion is complete (AIS A) because there is no sensory or motor sparing in
the lowest sacral segment.
d This patient’s lesion is complete (AIS A) because there is no sensory or motor sparing in
the lowest sacral segment.
Copyright © 2024 by F.A. Davis Company
All rights reserved. This material is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.
Use of this content outside your academic institution is expressly prohibited and enforceable by law.
